JOHN F. KENNEDY’S VISION FOR MENTAL HEALTH REMAINS UNFULFILLED By Rev. Bob Uzzel
On October 31, 1963—less than a month before his assassination--President
John F. Kennedy signed his last piece of legislation--the Community Mental Health Act. At the signing ceremony, Kennedy said that the legislation to build 1,500 centers would mean the population of those living in state mental hospitals — at that time more than 500,000 people — could be cut in half. In a special message to Congress earlier that year, he said the idea was to successfully and quickly treat patients in their own communities and then return them to “a useful place in society.”
This legislation helped to usher in positive life-altering changes for people with
serious illnesses such as schizophrenia, many of who now live normal, productive lives with jobs and families. In 1963, the average stay in a state institution for someone with schizophrenia was 11 years. But only half of the proposed centers were ever built, and those were never fully funded. In many cases, some of the sickest people have been discharged from state hospitals, only to end up homeless, abusing substances, or in prison. The three largest mental health providers in the nation today are jails: Cook County in Illinois, Los Angeles County in California, and Rikers Island in New York.
The 1963 legislation came amid other changes in treatment for the mentally ill
and health care policy in general. Chlorpromazine, better known as Thorazine, was the first effective antipsychotic medicine, released in the 1950s. That allowed many people who were mentally ill to leave institutions and live at home. In 1965, with the adoption of Medicaid, deinstitutionalization accelerated because states now had an incentive to move patients out of state hospitals, where they shouldered the entire cost of their care, and into communities where the federal government would pick up part of the tab.
Kennedy's legislation provided for $329 million to build mental health centers
that were supposed to provide services to people who had formerly been in institutions, as well as to reach into communities to try to prevent the occurrence of new mental disorders. Had the act been fully implemented, there would have been a single place in every community for people to go for mental health services. But one problem with the legislation was that it didn't provide money to operate the centers long-term. In the 1980s, during the administration of Ronald Reagan, the remaining funding for the act was converted into a mental health block grant for states, allowing them to spend it however they chose. Robert Drake, a professor of psychiatry and community and family medicine at Dartmouth College, said some states have tried to provide good community mental health care but added: "It's been very hard for them to sustain that because when state budget crunches come, it's always easiest to defund mental health programs."
Linda Rosenberg, president and CEO of the National Council for Behavioral
Health, counts among its 2,100 member organizations many of the original community mental health centers that were built under the 1963 legislation.
Former Congressman Patrick Kennedy, the son of the late Senator Edward
Kennedy and nephew of President Kennedy, recently organized “The Kennedy Forum,” an effort to bring mental health workers and advocates together to improve treatment for mental illness, addictions, and intellectual disabilities. The younger Kennedy, who represented Rhode Island from 1995 to 2011, was a coauthor of the 2008 Mental Health Parity and Addiction Equity Act. Six months before the 2006 election, he captured national attention when he crashed his Mustang into a Capitol security barrier in the middle of the night, telling police he was on his way to a vote, though the House wasn’t in session at the time. He checked into the Mayo Clinic the following day for treatment of bipolar disorder and addiction to prescription drugs. A month later, he received a standing ovation when he spoke at a mental health and addiction forum. When he returned to Congress, he made a point of thanking his colleagues who had sent him “get well” cards while he was in rehab. He came across story after story from members of Congress. He recalled: “All of them told me about how a parent committed suicide, or their spouse tried to commit suicide, or a daughter had an eating disorder, or a son a substance abuse disorder.”
On Wednesday October 23, the Kennedy Forum marked the 50th anniversary of
the Community Mental Health Act with a gala at the JFK Presidential Library. The speaker was Chicago Bears receiver Brandon Marshall, who has been treated for a personality disorder. On the following day, the organization held a conference at a Boston hotel. This conference included a panel discussion on public health and community approaches to addressing behavioral health disorders. Panelists included Chelsea Clinton and Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America (IAVA) and author of Chasing Ghosts
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